E016C – ASA V – moribund patient not expected to live 24 hours with or without operation
OHIP Surgical Assists Code — GENERAL PREAMBLE · Schedule of Benefits
An amount is payable for 20 extra units in addition to basic and time units when an anaesthesiologist administers an anaesthetic to a moribund patient not expected to live 24 hours with or without operation (ASA V). Per , the reference to ASA level for Physical Status Classification means the level determined by the anaesthesiologist at the time of the pre-operative anaesthesia assessment. This level does not vary if complications arise during surgery. E016C is not eligible for payment when anaesthesia is rendered to a brain dead patient for organ donations.
When to Use
- Use E016C when the patient is in a critical, moribund state prior to induction, such as a patient with multi-organ failure or massive trauma who is not expected to survive the next 24 hours.
- Apply this code when the pre-operative assessment confirms an ASA V status, even if the patient's condition appears to stabilize slightly during the procedure.
Common Pitfalls
- Claiming E016C for organ donation procedures is strictly prohibited and will result in automatic rejection.
- Attempting to upgrade a patient to ASA V mid-surgery due to unexpected intraoperative complications is invalid, as the ASA status must be determined at the pre-operative assessment per GP98.
- Confusing ASA V with ASA IV (E017C); ensure the patient meets the 'not expected to live 24 hours' threshold rather than just having severe, life-threatening systemic disease.
Billing Tips
- Always pair E016C with the appropriate emergency premium E020C if the surgery was booked within 24 hours to maximize the claim value for high-acuity cases.
- Ensure your pre-operative note explicitly documents the ASA V classification to satisfy audit requirements, as this is the primary determinant for the validity of the 20-unit premium.
No fee information available.
GP. General Preamble
GENERAL PREAMBLE
Premium
Anaesthesiologists' Services
The anaesthesiologist must determine the ASA level at the time of the pre-operative anaesthesia assessment.
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